## Facts

- Adree Edmo, a transgender woman incarcerated in the Idaho prison system, was diagnosed with gender dysphoria and received hormone therapy and mental health treatment while housed in a men’s facility.
- Despite ongoing treatment, Edmo experienced severe distress, suicidal ideation, and engaged in self-harm, including attempts at self-castration.
- Edmo’s experts testified that, under the World Professional Association for Transgender Health (WPATH) Standards of Care, she met clinical criteria for gender confirmation surgery (GCS) and that surgery was medically necessary for her condition.
- Idaho Department of Correction (IDOC) and its contracted medical provider, Corizon, through clinicians and officials, refused to provide GCS, asserting Edmo did not meet criteria and that hormones and counseling were sufficient; they also cited administrative and security concerns.
- Edmo sued under 42 U.S.C. § 1983, alleging deliberate indifference to a serious medical need in violation of the Eighth Amendment.
- After a bench trial, the district court entered injunctive relief requiring IDOC and Corizon to provide GCS and related care; defendants appealed.

## Issues

1. Whether Edmo’s gender dysphoria constituted a serious medical need posing a substantial risk of serious harm without appropriate treatment.
2. Whether defendants’ denial of GCS amounted to deliberate indifference under the Eighth Amendment rather than a permissible medical judgment or disagreement.
3. Whether deference to prison medical providers and administrators justified denial of GCS based on asserted clinical, security, or logistical concerns.

## Decision

- The Ninth Circuit affirmed the injunction requiring IDOC and Corizon to provide GCS to Edmo.
- The court held that Edmo’s severe gender dysphoria constituted a serious medical need and that the record supported a substantial risk of serious harm without effective treatment.
- The court agreed that defendants’ refusal of GCS, given the evidence of medical necessity under prevailing standards and knowledge of ongoing self-harm risk, was medically unacceptable and supported a finding of deliberate indifference.
- The court rejected arguments that generalized security or resource concerns, without adequate evidentiary support, excused denial of medically necessary care.
- The court upheld the injunction as tailored to Edmo’s circumstances, while limiting relief as to certain individual-capacity defendants where individual liability was not adequately supported.

## Legal Principles

- An Eighth Amendment medical-care claim requires (1) an objectively serious medical need and (2) a subjective showing that officials knew of and disregarded an excessive risk to health or safety.
- Deliberate indifference can be shown when officials persist in treatment that is medically unacceptable under the circumstances and do so in conscious disregard of an excessive risk of harm; it is more than negligence or malpractice.
- A “difference of medical opinion” does not defeat liability where the chosen course departs significantly from accepted professional judgment, practice, or standards.
- Courts may consider prevailing clinical standards in assessing adequacy of care and may order injunctive relief compelling necessary treatment when constitutional violations are proven.
- Deference to prison officials does not permit denial of medically necessary treatment based on conclusory or unsupported security, logistical, or cost assertions.

## Conclusion

The Ninth Circuit held that, on this record, Idaho and its prison medical contractor were deliberately indifferent to a transgender prisoner’s serious medical need by refusing medically necessary gender confirmation surgery despite evidence of severe distress and self-harm risk, and it affirmed an injunction requiring provision of the surgery.


Edmo v. Corizon, Inc., 935 F.3d 757 (9th Cir. 2019)